So,
prior to this night I have spent about a year or so at Grady and
thought I have seen how dysfunctional this place could. However, I was
mistaken. I truly witnessed a combination of extremely crazy patients
with severe neglect and inefficiency on the side of the staff and the
system.

My patient was a guy with schizophrenia who got hit in
the head with a metal pipe and had a 2 inch laceration on his forehead.
In addition to that his left hand was shackled to his bed and he also
had to urinate every 20-30 minutes. He was in a room with 2 other
patients. I cleaned his face and his wound with some saline and decided
to saw up his forehead. I spent about 20 minutes finding the right kind
of suture and then another 30 or so finding a mayo tray (if you don't
know what a mayo tray is google it) to set up all my equipment.

About
10 minutes after I started to saw him up he started yelling that he has
to go to the bathroom, normally I would hold a plastic duckie (angled
container into which men can pee if they direct their stream right)
while he directs his stream, however at this time I was wearing sterile
gloves and was not able to help him. So I thought he was gonna urinate
all over my equipment and I would have to start over. Luckily I was
able to find a nurse to help him. Right after that was over this
patient's neighbour who was drunk decided that he needed to masturbate
right then and there (he was about 2 feet away from my patient and
myself...hidden from my view by a strategically placed curtain) - I
heard the nurses screaming at him to stop and then calling security and
that patient screaming back (obviously not stopping what he was doing)
that he had "to get it out".

A few minutes later I heard loud
screams from the third neighbour in the room (he was admitted for
snorting 4 grams of cocaine) yelling at the nurses to take off the
shackles from his hand and that he will kill them once the shackles are
off. He also then mentioned that he spent the last 15 years in and out
of the penitentiary system and that he is "a hard mothafucka whodoesn't
let shit slide easy" - especially if he is dealing with snitches or
some who is trying to steal his money or his "dope" - "you just got to
deal with it right then and there" he said. Then he started discussing
how he was able to have sex with women while in prison he then went
into more detail into that subject (of note there is noone there
actually talking back to him).

His screams woke up my patient
who was sleeping while I was suturing his forehead and he started
moving his head right and left not letting me do my work. As a result,
I had to tell him every 5 second - "don't move your head MR.
_____...Don't move your head". He then started talking to his voices
and went off on a preaching monologue directed at his screaming
neighbour (earlier in our conversation he informed me that he is a
reverend..). Finally, after about 30 minutes or so I was able to saw
him up somehow managing not to stick myself while putting in his 8
stitches.

Then, I was lucky enough to get a malingering patient
who just got released from jail the day before and decided to us the
Emergency room as a hotel room - she called paramedics and told them
she had pain every where and then later admitted she smoked some crack
cocaine and drank a pint of wine a few hours prior - nvertheless she
was brought in to the ED. On review of systems (whenever I ask: "have
you had diarrhea?...chest pain?..headaches" in a list fashion) she
answered positively to every single question - it was quite impressive
that her story was changing every 5 minutes or so.

to make long
story short (i am tired of writng) - it was night of crazy patients and
nothing getting done to make it the most dysfunctional time I had at
that hospital to date. I would argue it is most dysfunctional and
inefficient hospital in the US.

posted on Saturday, March 03, 2007 2:20 AM

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My brother Michael is a doctor. During his time as US medical student he had a blog here - The Medstudent Experience. His last post as a student - A Night at the Grady Red Zone - caught my eye a while ago and I decided to give it some juice [ ... ]